VHA's patient-scheduling system 'broken'

Linda Halliday of the VA's Office of Inspector General testified before the Senate Veterans’ Affairs Committee on April 25 at a hearing that focused on VA’s mental health care.

legislative

Legislative Update

Take action on bills in Congress that affect veterans issues.

Nearly seven years after problems with wait-time data were uncovered, the Veterans Health Administration (VHA) still has a patient-scheduling system that is "broken," according to Linda Halliday of the Department of Veterans Affairs (VA) Office of Inspector General (OIG). And on April 25, Halliday testified before the Senate Veterans’ Affairs Committee (SVAC) at a hearing that focused on VA’s mental health care.

Sen. Patty Murray, D-Wash., opened the hearing as committee chair and quickly drew attention to an OIG report released April 23 that found VHA’s data on waiting times for mental health care patients was grossly inaccurate. Murray said the OIG findings "show some serious discrepancies in what VA has been telling this committee" and that "the existing scheduling system is hopelessly insufficient and needs to be replaced." She said VA "is failing to meet its own mandates for timeliness, and instead is finding ways to make the date look like they are complying."

While VHA reported, for fiscal year 2011, that 95 percent of first-time patients received full mental health evaluations within 14 days, Halliday testified that OIG’s analysis "projected that VHA provided only 49 percent (approximately 184,000) of first-time patients their evaluations within 14 days." The report also noted that VHA completed only 64 percent of new patient appointments within 14 days of their desired date.

"We found VHA’s mental-health performance data is not accurate or reliable," Halliday told the committee. "VHA’s measures do not adequately reflect critical dimensions of mental health-care access." She said that inaccuracies in data collected by VHA on mental-health staffing and productivity made it less useful for VHA decision-makers to "evaluate productivity across the system, and establish mental-health staffing and productivity standards."

American Legion National Commander Fang A. Wong said the hearing "shines a bright light on the problems VHA continues to have with its data collection on waiting times for our veterans being treated for mental-health issues. We can understand a four- or five-percent margin of error in these statistics, but they were off by almost 50 percent. How does one account for such wild inaccuracy by a federal agency? Especially one that is responsible for treating our veterans?"

Wong said the Legion has urged VA to increase its mental-health care staff and facilities. "Adding 1,900 more positions in mental health care is a step in the right direction, but it now appears they may be in need of some new data analysts at VHA." They should have gotten the message by now. We saw this problem crop up in two previous OIG audits — one in 2005 and another in 2007. And their patient-scheduling problem still isn’t fixed. The American Legion is asking the same question as Congress asked at the hearing: Why?"

The SVAC held two previous hearings on VA mental health care last year in July and November. Murray said the committee was finding "a discrepancy between what VA was telling us, and what the providers were saying" and called upon the VA’s OIG "to investigate the true availability of mental health-care services at VA facilities."

William Schoenhard, testifying for VA, agreed with OIG’s assessment that the patient-scheduling system needs to be revised. He also said mental-health services must continue to be further integrated into primary care, and that stigmas associated with mental health care need to be addressed. "Madame Chairman, we know our work to improve the delivery of mental health care to veterans will never be done. We appreciate your support and encouragement in identifying and resolving challenges, as we find new ways to care for veterans."

VA has been working to develop a new scheduling system for its patients. "VA officials told us that their new scheduling package would be open-sourced and could take up to two years to put into place," said Jacob Gadd, deputy director of health in the Legion’s Veterans Affairs & Rehabilitation Division. "We most assuredly applaud VA’s addition of 1,900 additional mental health-care workers, but without an accurate and effective scheduling system, how will optimal use be made of all those new clinicians and support staff?"

While the committee members asked many tough questions during the hearing, Murray made it clear that "while we have discussed a number of problems with the system at large, none of this reflects poorly on VA’s providers. I believe I can speak for all of us in thanking VA’s many mental health providers for the incredible job they do. Let there be no mistake, these individuals are incredibly dedicated in their mission."

More in Legislative Center

Sam Spook

First World Meds and Technologies Thwarted by
4th World VA Doctors.
Here in Georgia---with a few exceptions---VA
Medical is loathsome, demeaning, etc...
Example: In 2008 I went to our East Point
VA Clinic complaining of a burning pain in
my groin area which actually began with a
sharp pain similar to a hot ice pick being
shoved in my right groin area.
Hernia? VA Doctor James White said: "No!"
Was an X-Ray or Ultra-Sound ordered for the
groin or lower abdominal area?
VA Doctor James White said: "No!" But, an
X-Ray was ordered for my chest!? When the
X-Ray tech told me what Dr. White had ordered,
I asked her to confirm. She called; AND AGAIN
Dr. White refused to X-Ray or Ultra-Sound my
groin area.
After my chest was X-Rayed, Dr. White evaluated
my X-Ray. "You don't have TB," said Dr. White.
!!!!!!!!!!!
My family has a history of TB, BUT, NON-PULMONARY! Hips, spine, brain? Yes!
I again mentioned my family history.
Dr. White acted as if I didn't exist,
prescribed Gabapentin! which is very helpful
for people who've had a history of petit or
grand mal seizure---WHICH I NEVER HAD!
Dr. White poo-pooed my concerns and prescribed
what became a very high level of Gabapentin---
1500mg Gabapentin 3 times a day, or, 4500mg
Gabapentin per day before I went cold turkey.
Oh, BTW, a neighbor, Lamar Bramlett, who fought during Tet '68, had similar pains in his groin area, had it Ultra-Sounded by VA
and told: "The pain is just in your head, not
in your groin" and gave him some pain meds and
anti-psychotic meds.
Lamar took the VA Ultra-Sound and X-Rays to be
evaluated by non-VA doctors. The evaluating
doctors saw the VA Ultra-Sounds and scheduled
Lamar for surgery THAT DAY! Lamar had two
aneurysms in his femoral arteries that had
been pinching his nerves. Stents were put in
and now Lamar is pain free---NO THANKS TO
VA DOCTORS.

RetiredGreg

I think that the VA Mental Health as a hole needs to be overhauled as well as the entire appointment system. To be given an appointment at 1:00pm and told you are the 1st patient after lunch and have to wait 45 mins to an hour because the Dr is still working on the morning cases is not my concern. If you dont show at your scheduled time they move to the next and tell you to reschedule. By the Drs can take their time. My time is just as important. And to be misdiagnosis on top is something quite remarkable. Its only going to get worse.

kckclass

(HMO System Designer and Son): Bob Landry said it best: "The need for care greatly exceeds the supply of providers. A new scheduling package and new analysts to look at the data divert attention from the problem. Our nation needs to honor the veterans who have given their hearts and bodies to the service of all Americans." We are fortunate that many Vets claim the Palo Alto VHA is a cutting edge facility; near Stanford U it has some of the best physicians in the world. But recently an 88 year old WW-II D-Day+4 Vet and good friend went there and was sent into shock by a nurse, died 3 days later despite being a healthy man only days before his visit...a twisted story indeed. Poor training, lack of providers, poor Quality Assurance and Utilization Review Standards (QAUR) mean wasted taxpayer dollars spent on ineffective services. I know: I developed a complete 63 report QAUR system for a large HMO that turned them around and did it in a little over 3 months. For the VA to claim it takes 2 years means they hired software engineers who are idiots or someone is wasting another billion. I did it single handedly for under $20K and produced a package that went to HMOs all over the nation: lord knows what the VA will spend. In short, like the videos on youtube showing Haliburton giving our kids infected water in Afghanistan and Iraq, the VA is another dept designed to line the pockets of the corps/vendors while short changing the kids who put their lives on the line. But folks it ain't just the VA and I urge you vet, sons and women's aux to ban together and create a real change in 2012 or we can be assured that - as Jefferson warned us - we will wake up homeless on the continent our fathers conquered...and our kids defend.

JB1212

Service in Palo Alto and Menlo Park CA is excellent. (the mental health and physical health are in two places but under the same administration). They take a total person approach to health care and I have only had to wait once to see an endocrine specialist. They apologized profusely for the wait. Mental health has been another great help. In addition to clinicians, there are many self help groups like anger management and substance abuse. There are also scheduled seminars for such conditions as high blood pressure, high cholesterol and others. I cannot say enough good about this hospital.

MKECPO

While I have not have to use the VA Mental Health programs I have been a patient at the Milwaukee VA since 2003.
The service at the Milwaukee VA is fantastic. I almost never even get to sit down after checking in at my primary care clinic. Appointments for specialty care are always within a month and many time sooner. In civlian life I am an Industrial Engineer and help manufacturing and healthcare companies improve thier quality and productivity. The VA's productivity puts private healthcare systems to shame. Many private healthcare systems I have worked with or have read about would love to be more like the VA's healthcare system.

Eyemareader

I reckon it just depends on where your at. Here in Lubbock and Amarillo the care could not be better. I attend civilian care with my wife and my care is every bit as good and prompt as hers is. Actually in Amarillo you better be on time because your butt will not hit the chair before they are calling your name. Been going there 5/6 years now and it's that way every time.

george70446

It is very hard to get an appointment when needed, usual wait time is 2 to 3 months. I have called to talk with the nurse, got answer machine, left the proper information but it has been over a month and I have not heard from them. The prescription drug program is a wash out, they do not carry all medications that are needed, even if the doctor says Medically Necessary. I am 70% service connected but told that it dosen't matter for appointments.

Gramps0743

The Portland, OR hosp. has been doing reasonably well by me, back in "90" I got an appointment to see a Neurologist in a much shorter time than expected. The only gripe I have is than after being accepted for bariatric surgery funding for the program dried up and I never had the procedure.
Solving the VA's problems, on all fronts, could be accomplished in two simple steps. First fully fund the VA system and second get the hell out of the middle east.

Bob95490

The San Francisco VAMC Eye Clinic is a circle jerk on steroids with 2:15 appointments being seen at 5:30 or not at all (make another appointment to be ignored yet another day). The clinic meets the “seen within 15 minutes” requirement by shuffling patients in for a 2 minute schmooze and then returns the patient to waiting room hell to be ignored until long after the stipulated appointment time.
I began attempting to get care for my cataracts August 18, 2011 with a visit to the SFVAMC emergency room after having awakened unable to see out of my right eye at the instructions of my VA care provider (to circumvent the two month waiting period to get an appointment). The long emergency room wait was understandable due to triage requirements. However all five of my follow-up appointments at the SFVAMC eye clinic have either resulted in waiting times in excess of 2½ hours following which in three instances I’ve been required to reschedule and in the other two instances no stated reason for the delay was ever given and neither was any apology forthcoming. Instead, at my last appointment, I was told my loss of sight wasn’t life threatening and if I wanted my eyes fixed I should expect the same excessive waiting time with every visit.
When I requested the SFVAMC customer satisfaction/complaint form (like I received from the hospital’s surgical unit in June of 2011) I was given an envelope and a blank piece of paper and then ignored. With this sort of patient treatment my PTSD kicked in and by the time the doctor finally got around to seeing me I went off and asked point blank, “Do you even give a sh*t about the patients in the waiting room or are you here just to draw a paycheck you couldn’t receive in any other medical facility?”
Were I treated this way by the mental health clinic, instead of the eye clinic I would have just walked away and never returned. Unfortunately, going blind isn’t something I’d like to contemplate but I’m getting to the point where it is becoming a considered alternative to being ignored and treated like an inconvenience by those being paid to provide treatment. Nor should my care provider have had to tell me to use the emergency room to avoid a two month wait to be seen.
I and others that served this country should be treated in a timely manner and the VA “no longer than 15 minute wait to be treated” shouldn’t mean have a blood pressure and pulse rate check and then be ignored until hours after the scheduled appointment.
Robert Ireland (PUFL)
Post 174 Willits, CA

Alan Lubke

The complaint system at SFVAMC is atrocious. The patient advocate office is a small closet that is usually locked. When you the door is finally opened there is a stack of paperwork on the desk a "mile high". There is no direct telephone line from any of the clinics or the emergency room. Quality Assurance of the appointment system is the responsibility of the Sierra Pacific Network and they primarily rely on complaints submitted by the Medical Center's Patient Advocate Office. It is my fixed opinion that a large number of would be complaints never are received at the SFVAMC Patient Advocate Office (just like Mr. Ireland's), and secondly that even if received they are not forwarded or forwarded very late to the Sierra Pacific Network because of overload in the Patient Advocate's Office at SFVAMC. April 27, 2012.

B. Warrenfeltz

Martinsburg VA Hospital and surrounding clinics have a very good appointment system, have been using for over 20 years and never had a problem with duty or non duty related problems. Agree that I have no need for mental health evaluation but believe that in this day and age and the stress our comrades are under the system is not the problem, the lack of support from Washington is.

Bob Landry

I was a Mental Health Provider working for the VHA in Burlington, VT. I and my fellow providers worked our butt off. The scheduling system is not the problem. The problem is simple. The need for care greatly exceeds the supply of providers. A new scheduling package and new analysts to look at the data divert attention from the problem. Our nation needs to honor the veterans who have given their hearts and bodies to the service of all Americans. We have no problem sending 10 BILLION dollars to Pakistan. We have no problems with a tax rate to millionaires that is half that of the average citizen. We have no problem wasting billions in inane political campaigns. But when it comes to giving the Department of Veterans Affairs the resources it needs to meet the needs of the Vetarans, well we have to cut spending somewhere... It is far easier to point fingers and come up with excuses. Washington needs to WAKE UP! Sending our men and women off to war demands that when they come home we provide whatever care they need, no matter the cost. On the Battlefield, bombs and bullets are there aplenty. The same should be true for health care providers for veterans.

LieutenantCharlie

The Dayton VA, and the Middletown Outpateint Clinic are doing an outstanding job for all of us that go to these locations. My years, from 1969 to present, at the Dayton VA have been wonderful. Great care provided by a caring Staff.

drmorganson

It took over 3 MONTHS to get my "new patient" appointment & this after receiving a preliminary 40% Agent Orange disability in July 2011. It took over 6 MONTHS & intervention by our Senator's office to get a missed appointment rescheduled when the VHA made the appointment but we never received notification as we were out of town. I have yet to receive a mental health evaluation although it would only be a formality. Our facility in Reno bemoans the lousy scheduling system & is very honest when they tell us appointment are booked out at least 2 months if not longer. Yes, to say the system is broken is an gross understatement.